Healthcare Provider Details

I. General information

NPI: 1003089772
Provider Name (Legal Business Name): MICHAEL D MEADE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2008
Last Update Date: 03/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

471 E BROAD ST SUITE 1400
COLUMBUS OH
43215-3842
US

IV. Provider business mailing address

1331 N ELM ST SUITE 200
GREENSBORO NC
27401-6302
US

V. Phone/Fax

Practice location:
  • Phone: 614-221-3303
  • Fax:
Mailing address:
  • Phone: 336-274-9617
  • Fax: 336-482-2177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2013005685
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number35-123042
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: